Chronic Picking

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Permalink Reply by John Cleesattel on September 15, 2010 at 7:29pm

How about parts therapy to find out what the purpose is? Then go for a solution other than picking that still fulfills that purpose but yields a better outcome.

Just a thought
John

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Permalink Reply by Kelley Woods on September 15, 2010 at 7:51pm

Hi Jane,

Some people conduct this behavior as a form of emotional release, similar to self-injury tactics. I would begin by helping her anchor calm resource states and proceed with ego strengthening. As John suggests, parts work will probably be helpful in discovering the who, what, whens and whys...

A cognitive behavior approach for picking is to assign periods of time when she is "pick free" and gradually extend them, de-sensitizing her to the uncomfortable feelings. I think this would work best when she has those resource anchors to ground her.

Best wishes,

Kelley

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Permalink Reply by Jane Barter on September 15, 2010 at 8:57pm

Thanks Kelley
great advice. I did do parts with her today. It was a bit of a fishing expedition as no parts were willing to come forward, even with a lot of safety and compassion . I appealed to her protector, her healer as well as the part holding the issue, finally I got her inner wise voice to come forward and we did regress back to her 7yr old as well as a young adult. It was related to extreme overwhelm and perfectionism, fear of failure etc..... It was like sneaking in a back door ! the part related to this "picking" may need some more time to feel safe...I do feel there is a lot more there!
I will add more anchors in our next sessions with some breath work together with the Behavior Mod.
I like your explanation about the behavior being linked to emotional release , that makes sense to me. When I finally got her back into her 7yr old her hands became very warm, fussy, with an electric buzz! what I would equate as an energetic release although there was no emotional release! may take time.

Thanks so much for your input, so great to have colleague support.

Blessings

Jane

Kelley Woods said:

Hi Jane,

Some people conduct this behavior as a form of emotional release, similar to self-injury tactics. I would begin by helping her anchor calm resource states and proceed with ego strengthening. As John suggests, parts work will probably be helpful in discovering the who, what, whens and whys...

A cognitive behavior approach for picking is to assign periods of time when she is "pick free" and gradually extend them, de-sensitizing her to the uncomfortable feelings. I think this would work best when she has those resource anchors to ground her.

Best wishes,

Kelley

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Permalink Reply by Jane Barter on September 15, 2010 at 9:02pm

Thanks for your input John!
appreciate that. I did do parts today...they were very silent parts! so it took a lot of compassionate patience and some tricky negotiating but we did find some things to work on.

Cheers

Jane

John Cleesattel said:

How about parts therapy to find out what the purpose is? Then go for a solution other than picking that still fulfills that purpose but yields a better outcome.

Just a thought
John

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Permalink Reply by Bill Kennedy on September 16, 2010 at 1:57am

Hi Jane,

I have VERY limited experience in this area, but one thing I would check is that your client is getting enough vitamin D. The behavior started somewhere and I wonder whether there was some minor skin condition (e.g. psoriasis) that triggered the it.

Bill

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Permalink Reply by Adrian Tannock on September 16, 2010 at 2:51am

Hi Jane,

To understand picking / hair-pulling (trichotillomania) / nail & skin biting, it can help to run the behaviour through Norman and Shallice's Control of Action model. Here's something I wrote in 2008:

There has been a lot of researched carried out into behaviour. In 1986, two researches (Norman & Shallice) suggested a model of action control which puts forward the idea that automatic behaviour, comprised of routine and habit, and is governed by a modular system of “information models” or schemas. These schemas come into play either via external stimulus, or internal motivations. Tasks that can be classed as automatic are tasks that have become routine, and most often are performed without a conscious awareness of the pattern.

http://adriantannock.com/2008/07/11/wordle-will-and-more/

What this means is that a person can be picking their skin / hair, biting their nails etc, without having any awareness or control over the behaviour. At certain stages (say pain, bleeding or simply rising emotional dissatisfaction at the behaviour) that same person might phase into an awareness of the picking, but this is temporary, and often accompanied by a feeling and/or belief that the behaviour is too hard to control (followed then by a return to unawareness & more picking). In extreme cases, a person might even think "This hurts, I've got to stop doing it" whilst they continue to bite / pick / pull - as if their hand is controlled by somebody else!

So to put it in hypno-vernacular, the picking is being done by "the unconscious mind" and is (most usually) beyond the control of "the conscious mind".

Typical motivations for picking would be:

- a desire to neaten things up or make things better (e.g. compensation tied into negative self belief or anxiety when things are messy);
- a desire to release tension (as Kelley says) based on anxiety;
- a distraction from anxiety;
- a desire to externalise the pain they feel on the inside (this is often a factor in self-harm; I have encountered it when working with trichotillomania, not however with nail biting or finger-skin picking but it is possible)...

etc, etc.

When considering a resolution to the behaviour - there are a several components present:

1- The belief that this behaviour is beneficial (the motivation for the behaviour as per the examples stated above; the person may have an understanding that it is not beneficial , but the motivation to do it clearly trumps that).
2- The habit factor: via repetition, the behaviour has become entrenched.
3- Potentially, a belief that they cannot stop the behaviour (which then contributes to its repetition).
4- Underlying anxiety which 'fuels' the behaviour.

With that in mind, there may not be a single 'cause' to regress to, but rather an origin that is quite complex in structure. Successful interventions I've tried over the years:

- NLP-style 6-step reframe (using Grinder's refined version).
- A CBT approach (reinforced with hypnosis).
- De-potentiating significant emotional events (associated regression / dissociated v-k process) where required.

The determining factor for the use of regression is the level of anxiety present in a person in the here-and-now. The behaviour may have originated in times of low self-esteem / anxiety, but then they've moved on from that time, yet the behaviour persists mainly due to the beliefs that drive it plus the habitual reinforcement. A 'dry' habit, rather than a 'wet' one if you see what I mean. It's not a given that regression would be useful under those circumstances.

I hope that helps & good luck,

Cheers,

Adrian

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